Regenova, Inc.
Independent Consultant Application/Agreement/Kit Order Form
Consultant Information:
Last Name
First Name
Middle Initial
Mailing Address
City
State
(
(
)
Mobil Telephone
(
Zip Code
)
Home Telephone
)
Work Telephone
Email Address
Date of Birth
Driver’s License #
State Issued
Social Security Number
List the four people you plan to ask to book a Party with you in the next 3 weeks:
Date
Host Name
Mobile Phone Number, City, State
1. _____________ ________________________________ _______________________________________________
2. _____________ ________________________________ _______________________________________________
3. _____________ ________________________________ _______________________________________________
4. _____________ ________________________________ _______________________________________________
Are you currently or have you ever been, an active independent representative of any other
mlm/direct sales/party plan company?
Yes
No
If yes, name of company(s)? _________________________________________________________
Sales Kit Order Detail:
Cost of Consultant Sales Kit:
$
199.00
Local Sales Tax* ( _____ % of $199.00):
+ $ ___________
Shipping & Handling:
+ $ ___________
Total Cost
= $ ___________
Method of Payment: (Visa, Mastercard, American Express, Discover)
Credit Card Number
CVC code
Exp Date (Month Year)
I have read, understand and agree to be bound to the terms and conditions set forth and printed on the reverse side of this document. I understand that
my acceptance as a Consultant for ALLURICA is contingent upon written acceptance from REGENOVA, Inc. I authorize REGENOVA to debit my credit
card for the charges described above and I further agree to refrain from requesting a chargeback from my credit card processor for this charge.
_______________________________________________ ________________________
New Independent Consultant’s Signature
Date
_______________________________________________ ________________________
Recruiter’s/Sponsor’s Name (please print)
OFFICE USE ONLY
ID#
Regenova INDEPENDENT CONSULTANT AGREEMENT
1. A
uthorization and Contract. By executing the Regenova Independent Consultant Agreement (“Agreement”), you apply for legal authorization to become
a Regenova business owner and enter into contract with Regenova, Inc., hereinafter “Regenova.” You acknowledge that prior to signing you have received,
read and understood the Regenova Income Disclosure Statement, that you
have read and understood the Regenova Policies and Procedures, which are
incorporated into this Agreement and made part of it as if restated in full, as
posted on www.allurica.com, and that you have read and agree to all terms set
forth in this Agreement. Regenova reserves the right to reject any application
for any reason within 30 days of receipt.
2. E
xpiration, Renewal, and Termination. The term of this Agreement is one
year (subject to prior cancellation or disqualification as provided in the Policies
and Procedures). Continued participation in Regenova beyond the one-year
term will constitute acceptance for an additional term. If you fail to annually
renew your Regenova business, or if it is canceled or terminated for any reason, you understand that you will permanently lose all rights as an Independent
Consultant. You shall not be eligible to sell Regenova products and services
nor shall you be eligible to receive royalties, bonuses, or other income resulting
from the activities of your former downline sales organization. In the event of
cancellation, termination or nonrenewal, you waive all rights you have, including
but not limited to property rights, to your former downline organization and to
any bonuses, commissions or other remuneration derived through the sales
and other activities of your former downline organization. Regenova reserves
the right to terminate all Independent Consultant Agreements upon 30 days
notice if the Company elects to: (1) cease business operations; (2) dissolve as
a business entity; or (3) terminate distribution of its products and/or services via
direct selling channels. Independent Consultant may cancel this Agreement at
any time, and for any reason, upon written notice to Regenova at its principal
business address. Regenova may cancel this Agreement for any reason upon
30 days advance written notice to Independent Consultant. Regenova may
also take actions short of termination of the Agreement, if the Regenova Independent Consultant breaches any of its provisions.
3. I ndependent Contractor Status. You agree this authorization does not make
you an employee, agent, or legal representative of Regenova or your Sponsoring Independent Consultant. As a self-employed independent contractor, you
will be operating your own independent business, buying and selling products
available through Regenova on your own account. You have complete freedom
in determining the number of hours that you will devote to your business, and
you have the sole discretion of scheduling such hours. You will receive IRS
Form 1099-MISC reflecting the amount of income paid to you during the calendar year. By agreeing to these terms, you agree to receive the 1099-MISC form
via electronically. It will be your sole responsibility to account for such income
on your individual income tax returns.
4. Refunds and Product Returns. You agree that if you resell Product directly to
a customer, you will adhere to Regenova’s 100% satisfaction guarantee policy
and shall provide the customer a full refund of all monies paid if the customer
returns the product to you within thirty (30) days of the sales transaction. If you
are not 100% satisfied with our products, you may return the items for a refund
if neither you nor we have terminated the Agreement and the products were
purchased within twelve months and remain in resalable condition. The refund
shall be 90% of the purchase price. Shipping and handling charges incurred will
not be refunded.
5. Presenting the Plan. You agree when presenting the Regenova Compensation
Plan to present it in its entirety as outlined in official Regenova materials, emphasizing that sales to end consumers are required to receive compensation in
the form of bonuses on downline volume. In presenting the plan to prospects,
you agree not to utilize any literature, materials or aids not produced or specifically authorized in writing by Regenova. You agree to instruct all prospective Independent Consultants to review the Regenova Income Disclosure Statement.
6. S
elling Product. You agree to make no representations or claims about any
products beyond those shown on product labels and/or in official Regenova
literature. You further agree to sell products available through Regenova only in
authorized territories.
7. Regenova’s Proprietary Information and Trade Secrets. You recognize and
agree that, as further set forth in the Policies and Procedures, information compiled by or maintained by Regenova, including Line of Sponsorship (LOS) information (i.e., information that discloses or relates to all or part of the specific
arrangement of sponsorship within the Regenova business including, without
limitation, Independent Consultant lists, sponsorship trees, and all Regenova Independent Consultant information generated therefrom, in its present or future
forms), constitutes a commercially advantageous, unique and proprietary trade
secret of Regenova, which it keeps as proprietary and confidential and treats
as a trade secret. During the term of your contract with Regenova, Regenova
grants you a personal, non-exclusive, non-transferable and revocable right to
use trade secret, confidential, and proprietary business information (Proprietary
Information), which includes, without limitation, LOS information, business reports, manufacturing and product developments, and Independent Consultant
sales, earnings and other financial reports to facilitate your Regenova business.
8. N
on-Competition Agreement. In accordance with the Policies and Procedures, you agree that during the period while you are an Independent Consultant, and for six months following resignation, non-renewal, or termination of
your business, you will not compete with Regenova. This covenant shall survive
the expiration or termination of your authorization and contract with Regenova.
9. N
on-Solicitation Agreement. In accordance with the Policies and Procedures, you agree that during the period while you are a Independent Consultant, and for one calendar year following resignation, non-renewal, or termination of your business, you will not encourage, solicit, or otherwise attempt to
recruit or persuade any other Regenova Independent Consultant to compete
with the business of Regenova.
10. I mages / Recordings / Consents. You agree to permit Regenova to obtain
photographs, videos, and other recorded media of you or your likeness. You
acknowledge and agree to allow any such recorded media to be used by
Regenova for any lawful purpose, and without compensation.
11. M
odification of Terms. With the exception of the dispute resolution section
in Policies and Procedures, which can only be modified by way of mutual
consent, the terms of this Agreement may be modified as specified in Rule 1
in the Policies and Procedures.
12. Jurisdiction and Governing Law. The formation, construction, interpretation, and enforceability of your contract with Regenova as set forth in this
Independent Consultant Agreement and any incorporated documents shall be
governed by and interpreted in all respects under the laws of the State of Connecticut without regard to conflict of law provisions. Louisiana residents: notwithstanding the foregoing, Louisiana residents may bring an action against
Regenova, Inc. with jurisdiction and venue as provided by Louisiana law.
13. F
ax copy. A faxed copy of the Agreement shall be treated as an original in
all respects.
14. D
ispute Resolution. All disputes and claims relating to Regenova, its products and services, the rights and obligations of an Independent Consultant and Regenova, or any other claims or causes of action relating to the
performance of either an Independent Consultant or Regenova under the
Agreement or the Regenova Policies and Procedures shall be settled totally
and finally by arbitration as enumerated in the Policies and Procedures in
Glastonbury, Connecticut, or such other location as Regenova prescribes, in
accordance with the Federal Arbitration Act and the Commercial Arbitration
Rules of the American Arbitration Association, except that all parties shall be
entitled to discovery rights allowed under the Federal Rules of Civil Procedure.
Additionally, you agree not to initiate or participate in any class action
proceeding against Regenova, whether in a judicial or mediation or arbitration proceeding, and you waive all rights to become a member of any
certified class in any lawsuit or proceeding. This agreement to arbitrate
shall survive any termination or expiration of the Agreement. Nothing in the
Agreement shall prevent Regenova from applying to and obtaining from any
court having jurisdiction a writ of attachment, garnishment, temporary injunction, preliminary injunction, permanent injunction or other equitable relief available to safeguard and protect its interest prior to, during or following the filing
of any arbitration or other proceeding or pending the rendition of a decision or
award in connection with any arbitration or other proceeding.
15. T
ime Limitation. If an Independent Consultant wishes to bring an action
against Regenova for any act or omission relating to or arising from the
Agreement, such action must be brought within one year from the date of the
alleged conduct giving rise to the cause of action. Independent Consultant
waives all claims that any other statutes of limitations apply.
16. M
iscellaneous. If any provision of the Agreement is held to be invalid or unenforceable, such provision shall be reformed only to the extent necessary
to make it enforceable, and the balance of the Agreement will remain in full
force and effect. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original, but all of which together
shall constitute one instrument. The provisions of this Agreement, including all
documents incorporated herein by reference, embody the whole agreement
between you and Regenova and supersedes any prior agreements, understandings and obligations between you and Regenova concerning the subject
matter of your contract with Regenova.
17. M
ontana residents: A Montana resident may cancel his or her Independent
Consultant Agreement within 15 days from the date of enrollment, and may
return his or her starter kit for a full refund within such time period. Additionally,
all Montana residents are entitled to a twelve month refund on all unsold inventory and sales aids in the event of resignation or termination.
18. Notice of Right to Cancel. You may request a refund on your enrollment fee if
it’s done within seven business days from the date of enrollment. If you cancel,
any enrollment fees paid will be returned within TEN BUSINESS DAYS following receipt by the seller of your cancellation notice. To cancel this transaction,
mail or deliver written notice, to Regenova, Inc., 65 Cardinal Dr., Glastonbury,
CT, 06033, not later than midnight of the seventh business day following the
date of this Agreement.
19. S
ubmission of Electronic W-9. Under penalty of perjury, I certify that (1) the
number shown on this form is my correct taxpayer identification number (or
I am waiting for a number to be issued to me), and (2), I am not subject to
backup withholding because: (a) I am exempt from backup withholding, or (b)
I have not been notified by the Internal Revenue Service (IRS) that I am subject
to backup withholding as a result of a failure to report all interest or dividends,
or (c) the IRS has notified me that I am no longer subject to backup withholding, and (3) I am a U.S. Citizen or other U.S. person.